If necessity is the mother of invention, then perhaps there has never been a more urgent need for innovation to tackle the COVID-19 pandemic. As the pandemic made strongholds across the world, it quickly tore through crocheted defences against viruses. Unmet needs quickly emerged – for treatment, for diagnostic testing, for surveillance, for increasing Intensive Care Unit (ICU) capacities and for skilled medical staff and the Personal Protective Equipment (PPE) to protect them [1]. As countries attempt to reopen their economies, further challenges are materialising – such as managing the burden created by the postponement of elective surgeries [2].

Innovation has been stitching our defences back together again, and in time will give us our weapons for counter-attack ­– treatments and vaccines. This incredible, agile response to the crisis has been led by a thriving international community of innovators. While home 3D printing enthusiasts have come together online to produce PPE and ventilator valves [3], competing multinational corporations have formed new consortiums of unlikely ‘friends’, sharing intellectual property and resources to produce what countries need most [1].

On the front line, hospital staff are innovating to make the most of limited resources available to them - in response to testing kit shortages, academics at Maluana Azad Medical College (New Delhi, India) evaluated ‘pooled sample testing’ to maximise efficiency. Experts and amateurs across nations have amassed to confront new COVID-19 related healthcare challenges as they appear, leaping over social distancing barriers with virtual hackathons [4-8].

Finally, innovators from High-Income Countries (HICs) and Low and Middle-Income Countries (LMICs) have come together under initiatives like Project CARE, led by the United Kingdom’s Royal Academy of Engineering (UK RAEng), supporting local entrepreneurs in Sub-Saharan Africa to develop, manufacture and distribute life-saving PPE [9].

Figure 1: Venturi valves being manufactured on a 3D printer at the University of Leeds [10]

Of particular interest is that HIC healthcare systems began to desperately seek innovations developed for LMICs. This process, commonly known as reverse innovation, is now saving lives in HICs. In the UK, Frontier Technologies released an urgent call for emerging market ventilator systems to be adapted for in-country manufacture. These systems, like Diamedica’s ‘Helix’ [11], are built frugally with a focus on simplicity, quality and core functionality rather than being ‘state of the art’.

In a crisis such as a pandemic, simplicity is their advantage - they can be rapidly manufactured at low cost. Other advantages may be more subtle: when all laparoscopic surgeries were postponed in many countries due to fears of aerosolized virus transmission, UK surgeons sought alternative options.

One potential solution is Gas Insufflation-Less Laparoscopic Surgery (GILLS) – used in remote facilities in North-East India [12] . This simple, low-cost technology, removing the need for pressurised gas and general anaesthetic, could be used to reduce viral transmission during surgery.

Figure 2: GILLS Surgery in Northeast India

These technologies exist and are available to HICs because in LMICs, the mother of invention is always present. The additional challenges LMICs consistently face make responding to outbreaks even harder. Their often already over-burdened healthcare systems may be unable to meet minimum Infection, Prevention and Control (IPC) requirements with inadequate hygiene facilities and an absolute lack of PPE and IPC trained staff available.

Insufficient financial, public health and surveillance resources are available for their governments to draw on. Amongst all of this, mistrust of the government and healthcare workers in some countries can hinder the unified response needed to combat outbreaks. Finally, in some areas, such as refugee camps and densely packed slums, conforming to social distancing is simply impossible [13, 14].

If innovations developed for LMICs can help rescue healthcare systems in HICs during a global crisis so seamlessly, then the compelling potential of innovations to address every unremitting, day-by-day crisis faced by healthcare systems in LMICs must be explored. In Part 2, we will address how innovators can disseminate this powerful potential for the benefit of HICs and LMICs alike.